Prédiction des complications après duodénopancréatectomie céphalique: validation d'un score de complications postopératoires = Prediction of complications after pancreaticoduodenectomy: validation of a postoperative complication score

Objectifs La chirurgie pancréatique reste associée à une morbidité postopératoire importante. Les efforts sont concentrés la plupart du temps sur la diminution de cette morbidité, mais la détection précoce de patients à risque de complications pourrait être une autre stratégie valable. Un score simple de prédiction des complications après duodénopancréatectomie céphalique a récemment été publié par Braga et al. La présente étude a pour but de valider ce score et de discuter de ses possibles implications cliniques. Méthodes De 2000 à 2015, 245 patients ont bénéficié d'une duodénopancréatectomie céphalique dans notre service. Les complications postopératoires ont été recensées selon la classification de Dindo et Clavien. Le score de Braga se base sur quatre paramètres : le score ASA (American Society of Anesthesiologists), la texture du pancréas, le diamètre du canal de Wirsung (canal pancréatique principal) et les pertes sanguines intra-opératoires. Un score de risque global de 0 à 15 peut être calculé pour chaque patient. La puissance de discrimination du score a été calculée en utilisant une courbe ROC (receiver operating characteristic). Résultats Des complications majeures sont apparues chez 31% des patients, alors que 17% des patients ont eu des complications majeures dans l'article de Braga. La texture du pancréas et les pertes sanguines étaient statistiquement significativement corrélées à une morbidité accrue. Les aires sous la courbe étaient respectivement de 0.95 et 0.99 pour les scores classés en quatre catégories de risques (de 0 à 3, 4 à 7, 8 à 11 et 12 à 15) et pour les scores individuels (de 0 à 15). Conclusions Le score de Braga permet donc une bonne discrimination entre les complications mineures et majeures. Notre étude de validation suggère que ce score peut être utilisé comme un outil pronostique de complications majeures après duodénopancréatectomie céphalique. Les implications cliniques, c'est-à-dire si les stratégies de prise en charge postopératoire doivent être adaptées en fonction du risque individuel du patient, restent cependant à élucider. -- Objectives Pancreatic surgery remains associated with important morbidity. Efforts are most commonly concentrated on decreasing postoperative morbidity, but early detection of patients at risk could be another valuable strategy. A simple prognostic score has recently been published. This study aimed to validate this score and discuss possible clinical implications. Methods From 2000 to 2012, 245 patients underwent pancreaticoduodenectomy. Complications were graded according to the Dindo-Clavien classification. The Braga score is based on American Society of Anesthesiologists score, pancreatic texture, Wirsung duct diameter, and blood loss. An overall risk score (from 0 to 15) can be calculated for each patient. Score discriminant power was calculated using a receiver operating characteristic curve. Results Major complications occurred in 31% of patients compared to 17% in Braga's data. Pancreatic texture and blood loss were independently statistically significant for increased morbidity. The areas under curve were 0.95 and 0.99 for 4-risk categories and for individual scores, respectively. Conclusions The Braga score discriminates well between minor and major complications. Our validation suggests that it can be used as prognostic tool for major complications after pancreaticoduodenectomy. The clinical implications, i.e., whether postoperative treatment strategies should be adapted according to the patient's individual risk, remain to be elucidated.

Effect of radar rainfall time resolution on the predictive capability of a distributed hydrologic model

The performance of a hydrologic model depends on the rainfall input data, both spatially and temporally. As the spatial distribution of rainfall exerts a great influence on both runoff volumes and peak flows, the use of a distributed hydrologic model can improve the results in the case of convective rainfall in a basin where the storm area is smaller than the basin area. The aim of this study was to perform a sensitivity analysis of the rainfall time resolution on the results of a distributed hydrologic model in a flash-flood prone basin. Within such a catchment, floods are produced by heavy rainfall events with a large convective component. A second objective of the current paper is the proposal of a methodology that improves the radar rainfall estimation at a higher spatial and temporal resolution. Composite radar data from a network of three C-band radars with 6-min temporal and 2 × 2 km2 spatial resolution were used to feed the RIBS distributed hydrological model. A modification of the Window Probability Matching Method (gauge-adjustment method) was applied to four cases of heavy rainfall to improve the observed rainfall sub-estimation by computing new Z/R relationships for both convective and stratiform reflectivities. An advection correction technique based on the cross-correlation between two consecutive images was introduced to obtain several time resolutions from 1 min to 30 min. The RIBS hydrologic model was calibrated using a probabilistic approach based on a multiobjective methodology for each time resolution. A sensitivity analysis of rainfall time resolution was conducted to find the resolution that best represents the hydrological basin behaviour.

La intensificación agrícola y la diversidad vegetal en los sistemas cerealistas de secano mediterráneos: implicaciones para la conservación

El trabajo analiza la importancia de la diversidad vegetal en los agroecosistemas y los efectos de la intensificación de las prácticas agrícolas y del paisaje sobre la diversidad vegetal. La revisión de diversos estudios llevados a cabo por el equipo de investigación permite destacar que la intensificación agrícola, tanto a escala de campo como de paisaje, afecta negativamente la abundancia y la riqueza específica de la flora. La comparación de la flora arvense de los cultivos cerealistas de secano mediterráneos entre los años 50 y la actualidad refleja la reducción de la flora arvense, especialmente de la flora propia de las mieses y la disminución de la abundancia de grupos funcionales como las leguminosas y las plantas entomófilas. El efecto de las prácticas agrícolas y de la complejidad del paisaje varía en función de la flora estudiada. Así, la complejidad del paisaje es el principal factor que afecta la configuración de la vegetación de los márgenes, mientras que la intensidad de las prácticas agrícolas es el principal factor para explicar las diferencias en la flora arvense en el centro de los campos. Por último, el artículo analiza diversas propuestas para la gestión de los agrosistemas con el objetivo de conciliar la producción agrícola y la conservación de la biodiversidad en la región mediterránea.

Manipulation of arthropod sex determination by endosymbionts: diversity and molecular mechanisms.

Arthropods exhibit a large variety of sex determination systems both at the chromosomal and molecular level. Male heterogamety, female heterogamety, and haplodiploidy occur frequently, but partially different genes are involved. Endosymbionts, such as Wolbachia, Cardinium,Rickettsia, and Spiroplasma, can manipulate host reproduction and sex determination. Four major reproductive manipulation types are distinguished: cytoplasmic incompatibility, thelytokous parthenogenesis, male killing, and feminization. In this review, the effects of these manipulation types and how they interfere with arthropod sex determination in terms of host developmental timing, alteration of sex determination, and modification of sexual differentiation pathways are summarized. Transitions between different manipulation types occur frequently which suggests that they are based on similar molecular processes. It is also discussed how mechanisms of reproductive manipulation and host sex determination can be informative on each other, with a special focus on haplodiploidy. Future directions on how the study of endosymbiotic manipulation of host reproduction can be key to further studies of arthropod sex determination are shown.

La Pedagogia al deixant del segle XX

No hi ha dubte que la pedagogia, com a filia directa de la 1I·lustració, ha estat un gran projecte modern De fet, foren els somnis deis il·lustrats -amb Kant al capdavant- els que precipitaren l'aparició d'una disciplina que busca la regeneració de la societat a través de l'educació, tal com van plantejar els reformadors neohumanistes de la segona meitat del segle XVIII en desenvolupar la idea de la Bildung (entesa com a teoria de la formació humana).1 El cas és que filantropia, reformisme i pedagogia constitueixen els tres pilars d'una gran il·lusió: irradiar una nova consciencia moral i social per tal d'aconseguir individus amb més autonomia i, al hora, una societat més lliure i emancipada.

On the Analysis and Control of a Linear Synchronous Servomotor with a Flexible Load

Industry's growing need for higher productivity is placing new demands on mechanisms connected with electrical motors, because these can easily lead to vibration problems due to fast dynamics. Furthermore, the nonlinear effects caused by a motor frequently reduce servo stability, which diminishes the controller's ability to predict and maintain speed. Hence, the flexibility of a mechanism and its control has become an important area of research. The basic approach in control system engineering is to assume that the mechanism connected to a motor is rigid, so that vibrations in the tool mechanism, reel, gripper or any apparatus connected to the motor are not taken into account. This might reduce the ability of the machine system to carry out its assignment and shorten the lifetime of the equipment. Nonetheless, it is usually more important to know how the mechanism, or in other words the load on the motor, behaves. A nonlinear load control method for a permanent magnet linear synchronous motor is developed and implemented in the thesis. The purpose of the controller is to track a flexible load to the desired velocity reference as fast as possible and without awkward oscillations. The control method is based on an adaptive backstepping algorithm with its stability ensured by the Lyapunov stability theorem. As a reference controller for the backstepping method, a hybrid neural controller is introduced in which the linear motor itself is controlled by a conventional PI velocity controller and the vibration of the associated flexible mechanism is suppressed from an outer control loop using a compensation signal from a multilayer perceptron network. To avoid the local minimum problem entailed in neural networks, the initial weights are searched for offline by means of a differential evolution algorithm. The states of a mechanical system for controllers are estimated using the Kalman filter. The theoretical results obtained from the control design are validated with the lumped mass model for a mechanism. Generalization of the mechanism allows the methods derived here to be widely implemented in machine automation. The control algorithms are first designed in a specially introduced nonlinear simulation model and then implemented in the physical linear motor using a DSP (Digital Signal Processor) application. The measurements prove that both controllers are capable of suppressing vibration, but that the backstepping method is superior to others due to its accuracy of response and stability properties.

New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.

INTRODUCTION: The decline of malaria and scale-up of rapid diagnostic tests calls for a revision of IMCI. A new algorithm (ALMANACH) running on mobile technology was developed based on the latest evidence. The objective was to ensure that ALMANACH was safe, while keeping a low rate of antibiotic prescription. METHODS: Consecutive children aged 2-59 months with acute illness were managed using ALMANACH (2 intervention facilities), or standard practice (2 control facilities) in Tanzania. Primary outcomes were proportion of children cured at day 7 and who received antibiotics on day 0. RESULTS: 130/842 (15∙4%) in ALMANACH and 241/623 (38∙7%) in control arm were diagnosed with an infection in need for antibiotic, while 3∙8% and 9∙6% had malaria. 815/838 (97∙3%;96∙1-98.4%) were cured at D7 using ALMANACH versus 573/623 (92∙0%;89∙8-94∙1%) using standard practice (p<0∙001). Of 23 children not cured at D7 using ALMANACH, 44% had skin problems, 30% pneumonia, 26% upper respiratory infection and 13% likely viral infection at D0. Secondary hospitalization occurred for one child using ALMANACH and one who eventually died using standard practice. At D0, antibiotics were prescribed to 15∙4% (12∙9-17∙9%) using ALMANACH versus 84∙3% (81∙4-87∙1%) using standard practice (p<0∙001). 2∙3% (1∙3-3.3) versus 3∙2% (1∙8-4∙6%) received an antibiotic secondarily. CONCLUSION: Management of children using ALMANACH improve clinical outcome and reduce antibiotic prescription by 80%. This was achieved through more accurate diagnoses and hence better identification of children in need of antibiotic treatment or not. The building on mobile technology allows easy access and rapid update of the decision chart. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201011000262218.

Towards high-quality simultaneous EEG-fMRI at 7T: Detection and reduction of EEG artifacts due to head motion.

The enhanced functional sensitivity offered by ultra-high field imaging may significantly benefit simultaneous EEG-fMRI studies, but the concurrent increases in artifact contamination can strongly compromise EEG data quality. In the present study, we focus on EEG artifacts created by head motion in the static B0 field. A novel approach for motion artifact detection is proposed, based on a simple modification of a commercial EEG cap, in which four electrodes are non-permanently adapted to record only magnetic induction effects. Simultaneous EEG-fMRI data were acquired with this setup, at 7T, from healthy volunteers undergoing a reversing-checkerboard visual stimulation paradigm. Data analysis assisted by the motion sensors revealed that, after gradient artifact correction, EEG signal variance was largely dominated by pulse artifacts (81-93%), but contributions from spontaneous motion (4-13%) were still comparable to or even larger than those of actual neuronal activity (3-9%). Multiple approaches were tested to determine the most effective procedure for denoising EEG data incorporating motion sensor information. Optimal results were obtained by applying an initial pulse artifact correction step (AAS-based), followed by motion artifact correction (based on the motion sensors) and ICA denoising. On average, motion artifact correction (after AAS) yielded a 61% reduction in signal power and a 62% increase in VEP trial-by-trial consistency. Combined with ICA, these improvements rose to a 74% power reduction and an 86% increase in trial consistency. Overall, the improvements achieved were well appreciable at single-subject and single-trial levels, and set an encouraging quality mark for simultaneous EEG-fMRI at ultra-high field.

Innovar, renovar, avaluar

[eng] The new educational context in which we are involved and the facilities of the TIC (Communication Information Technologies) have led to the necessary modification of didactic approach that during years has been used for Pharmaceutical Technology teaching. However, changes/updating and innovation require a simultaneous reflection in order to avoid excessive dispersion of the approach and to channel adequately the pedagogic and didactic effort. On the other hand, it is necessary to evaluate the above initiatives to determinate if these one are on the right track. The Pharmaceutical Technology Teaching Innovation Group of the University of Barcelona has been formed and consolidated in this point of view. In this work, a review of studies carried on by the group, in the exposed purposes, from the beginning of their activities is presented. [spa] El nuevo contexto docente en el que estamos inmersos así como las posibilidades de las TIC (Tecnologías de la Información y de la Comunicación) han conllevado la necesaria modificación de los planteamientos didácticos que durante años han servido de base para las enseñanzas de la Tecnología Farmacéutica. Sin embargo, la renovación/actualización e innovación precisan de una simultánea reflexión a fin de evitar una excesiva dispersión del enfoque y para encauzar adecuadamente el esfuerzo pedagógico y didáctico. Por otra parte, es necesario evaluar dichas iniciativas para determinar si están bien encaminadas. El Grupo de Innovación Docente de Tecnología Farmacéutica de la Universidad de Barcelona se ha creado y consolidado desde esta óptica. En este trabajo se presentan un conjunto de estudios que el grupo ha llevado a cabo, con los fines expuestos, desde el comienzo de sus actividades.

Las emociones como variables relacionadas con el cambio de hábitos de salud en familiares y amigos próximos de enfermos de cáncer

Study of the changes in health habits of 105 cancer patients’ relatives and close friends after the diagnosis. The aim is to try to verify whether the knowledge of the disease has got some impact in the modification of their life styles. The emotional alterations influence in this change of behaviour has been analysed futhermore. An interview of own creation and HADS (Anxiety Hospital and Depression Scale of Zigmond and Snaith, 1983) instrument, in a Spanish and a Catalan version, were used with this aim. The results show that 21.1% of the participants presented positive changes in their health habits after the diagnosis of the relative or close friend and 11.5% showed negative changes. In relation to the role of the emotions, averages of anxiety (14,33; d.t.=4,98) and depressive (10,17; d.t.=4,93) symptoms were higher in those subjects who made negative changes than in those who did not make any change (9,32; d.t.=5,37 and 6,33; d.t.=4,64). In addition, the youngest participants, with more depressive symptoms and who visit the subject more often, are those who become more assets modifying health habits. The results suggest that emotional alterations, mainly depressive symptoms, are associated with negative change and, therefore, it would be suitable to lend some type of attention to these alterations in the population studied with the purpose of improving their present and future health

Spatial pattern of landslides in Swiss Rhone valley

The present study analyses the spatial pattern of quaternary gravitational slope deformations (GSD) and historical/present-day instabilities (HPI) inventoried in the Swiss Rhone Valley. The main objective is to test if these events are clustered (spatial attraction) or randomly distributed (spatial independency). Moreover, analogies with the cluster behaviour of earthquakes inventoried in the same area were examined. The Ripley's K-function was applied to measure and test for randomness. This indicator allows describing the spatial pattern of a point process at increasing distance values. To account for the non-constant intensity of the geological phenomena, a modification of the K-function for inhomogeneous point processes was adopted. The specific goal is to explore the spatial attraction (i.e. cluster behaviour) among landslide events and between gravitational slope deformations and earthquakes. To discover if the two classes of instabilities (GSD and HPI) are spatially independently distributed, the cross K-function was computed. The results show that all the geological events under study are spatially clustered at a well-defined distance range. GSD and HPI show a similar pattern distribution with clusters in the range 0.75?9 km. The cross K-function reveals an attraction between the two classes of instabilities in the range 0?4 km confirming that HPI are more prone to occur within large-scale slope deformations. The K-function computed for GSD and earthquakes indicates that both present a cluster tendency in the range 0?10 km, suggesting that earthquakes could represent a potential predisposing factor which could influence the GSD distribution.

Investigation and data adaptive analysis of CARS spectra

In this diploma work advantages of coherent anti-Stokes Raman scattering spectrometry (CARS) and various methods of the quantitative analysis of substance structure with its help are considered. The basic methods and concepts of the adaptive analysis are adduced. On the basis of these methods the algorithm of automatic measurement of a scattering strip size of a target component in CARS spectrum is developed. The algorithm uses known full spectrum of target substance and compares it with a CARS spectrum. The form of a differential spectrum is used as a feedback to control the accuracy of matching. To exclude the influence of a background in CARS spectra the differential spectrum is analysed by means of its second derivative. The algorithm is checked up on the simulated simple spectra and on the spectra of organic compounds received experimentally.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.